Publications by authors named "Anne Rollin"

73 Publications

Relationships between left ventricular mass and QRS duration in diverse types of left ventricular hypertrophy.

Eur Heart J Cardiovasc Imaging 2021 Apr 11. Epub 2021 Apr 11.

Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France.

Aims: Hypertrophic cardiomyopathy (HCM) may be associated with very narrow QRS, while left ventricular hypertrophy (LVH) may increase QRS duration. We investigated the relationships between QRS duration and LV mass (LVM) in subtypes of abnormal LV wall thickness.

Methods And Results: Automated measurement of LVM on MRI was correlated to automated measurement of QRS duration on ECG in HCM, left ventricular non compaction (LVNC), left ventricular hypertrophy (LVH), and controls with healthy hearts. Uni and multivariate analyses were performed between groups including explanatory variables expected to influence LVM and QRS duration. The relationships between QRS duration and LVM were further studied within each group. Two hundred and twenty-one HCM, 28 LVNC, 16 LVH, and 40 controls were retrospectively included. Mean QRS duration was 92 ms for HCM, 104 for LVNC, 110 for LVH, and 92 for controls (P < 0.01). Mean LVM was 100, 90, 108, and 68 g/m2 (P < 0.01). QRS duration, LVM, hypertension, maximal wall thickness, and late gadolinium enhancement were significantly linked to HCM in multivariate analysis (w/wo bundle branch block). An independent negative correlation was found between LVM and QRS duration in the HCM group, while the relationship was reverse in LVNC, LVH, and controls.

Conclusion: QRS duration increases with LVM in LVNC, LVH, or in healthy hearts, while reverse relationship is present in HCM. These relationships were independent from other parameters. These results warrant additional investigations for refining diagnosis criteria for HCM in the future.
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http://dx.doi.org/10.1093/ehjci/jeab063DOI Listing
April 2021

Wearable cardioverter-defibrillator in patients with a transient risk of sudden cardiac death: the WEARIT-France cohort study.

Europace 2021 Jan;23(1):73-81

Department of Cardiology, General Hospital of Cannes, 06150 Cannes, France.

Aims : We aimed to provide contemporary real-world data on wearable cardioverter-defibrillator (WCD) use, not only in terms of effectiveness and safety but also compliance and acceptability.

Methods And Results : Across 88 French centres, the WEARIT-France study enrolled retrospectively patients who used the WCD between May 2014 and December 2016, and prospectively all patients equipped for WCD therapy between January 2017 and March 2018. All patients received systematic education session through a standardized programme across France at the time of initiation of WCD therapy and were systematically enrolled in the LifeVest Network remote services. Overall, 1157 patients were included (mean age 60 ± 12 years, 16% women; 46% prospectively): 82.1% with ischaemic cardiomyopathy, 10.3% after implantable cardioverter-defibrillator explant, and 7.6% before heart transplantation. Median WCD usage period was 62 (37-97) days. Median daily wear time of WCD was 23.4 (22.2-23.8) h. In multivariate analysis, younger age was associated with lower compliance [adjusted odds ratio (OR) 0.97, 95% confidence interval (CI) 0.95-0.99, P < 0.01]. A total of 18 participants (1.6%) received at least one appropriate shock, giving an incidence of appropriate therapy of 7.2 per 100 patient-years. Patient-response button allowed the shock to be aborted in 35.7% of well-tolerated sustained ventricular arrhythmias and in 95.4% of inappropriate ventricular arrhythmia detection, finally resulting in an inappropriate therapy in eight patients (0.7%).

Conclusion: Our real-life findings reinforce previous studies on the efficacy and safety of the WCD in the setting of transient high-risk group in selected patients. Moreover, they emphasize the fact that when prescribed appropriately, in concert with adequate patient education and dedicated follow-up using specific remote monitoring system, compliance with WCD is high and the device well-tolerated by the patient.
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http://dx.doi.org/10.1093/europace/euaa268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842091PMC
January 2021

Incidence, epidemiology, diagnosis and prognosis of atrio-oesophageal fistula following percutaneous catheter ablation: a French nationwide survey.

Europace 2021 Apr;23(4):557-564

Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France.

Aims: Rate, incidence, risk factors, and optimal management of atrio-oesophageal fistula (AOF) after catheter ablation for atrial fibrillation (AF) remain obscure.

Methods And Results: All French centres performing AF ablation were identified and surveys were sent concerning the number of procedures, eventual cases of AOF, and characteristics of such cases. Eighty-two of the 103 centres (80%) performing AF ablation in France were included, with a total of 129 286 AF ablations since 2006 (93% of the whole procedures in France). Thirty-three AOF were reported (reported rate 0.026% per procedure) with a stable reported annual incidence despite the increasing number of procedures. Sensitivity of computed tomography (CT) scan for AOF was 81%. Mortality was 60%, significantly lower in case of surgical corrective therapy (31 vs. 93%, P = 0.001).

Conclusion: The reported rate of AOF after AF ablation in this nationwide survey was 0.026%, with a stable reported annual incidence over time. A normal CT scan does not rule out the diagnosis and should be repeated in case of suspicion. Prognosis remains poor with a mortality of 60% and crucially dependant of immediate surgical correction. No clear protective strategy has been proven effective.
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http://dx.doi.org/10.1093/europace/euaa278DOI Listing
April 2021

Long-Lasting Ventricular Fibrillation in Humans ECG Characteristics and Effect of Radiofrequency Ablation.

Circ Arrhythm Electrophysiol 2020 10 10;13(10):e008639. Epub 2020 Sep 10.

LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.).

Background: Studies of ventricular fibrillation (VF) in humans are limited because of the short available duration. We sought to study surface ECG waveforms and effect of ablation in long-lasting VF in patients with left assist devices.

Methods: Continuous 12-lead ECG of 5 episodes of long-lasting VF occurring in 3 patients with left ventricular assist device were analyzed. Spectral analysis (dominant frequency) and quantification of waveform amplitude, regularity (Unbiased Regularity Index), and complexity (Nondipolar Index) were performed over a median of 24 minutes of VF. Radiofrequency ablation was performed during VF in 2 patients.

Results: There was a significant increase in dominant frequency between VF onset and termination but none of the other parameters significantly changed. Some VF parameters varied from patient to patient and from lead to lead. Dominant frequency decreased after radiofrequency ablation in both cases and VF terminated spontaneously shortly after ablation in one case. The previously incessant VFs in these 2 patients did not recur afterward.

Conclusions: VF rate increases over time in patients with left ventricular assist devices and is lowered by ablation. Long-lasting VF may be modified or even terminated by ablation.
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http://dx.doi.org/10.1161/CIRCEP.120.008639DOI Listing
October 2020

Coagulation and heparin requirements during ablation in patients under oral anticoagulant drugs.

J Arrhythm 2020 Aug 19;36(4):644-651. Epub 2020 May 19.

Hematology laboratory University Hospital Rangueil Toulouse France.

Background: Anticoagulation during catheter ablation should be closely monitored with activated clotting time (ACT). However vitamin K antagonists (VKA) or direct oral anticoagulant drugs (DOAC) may act differently on ACT and on heparin needs. The aim of this study was to compare ACT and heparin requirements during catheter ablation under various oral anticoagulant drugs and in controls.

Methods: Sixty consecutive patients referred for ablation were retrospectively included: group I (n = 15, VKA), group 2 (n = 15, uninterrupted rivaroxaban), group 3 (n = 15, uninterrupted apixaban), and group 4 (n = 15, controls). Heparin requirements and ACT were compared throughout the procedure.

Results: Heparin requirements during the procedure were significantly lower in patients under VKA compared to DOAC, but similar between DOAC patients and controls.Activated clotting time values were significantly higher in patients under VKA compared to DOAC and similar in DOAC patients versus controls. Furthermore, anticoagulation control as evaluated by the number/proportion of ACT> 300 as well as the time passed over 300 seconds was significantly better in patients under VKA versus DOAC, without significant differences between DOAC and controls. Finally, the number of patients/ACT with excessive ACT values was significantly higher in VKA versus DOAC patients versus controls.There was no significant difference between rivaroxaban and apixaban for ACT or heparin dosing throughout the procedure.

Conclusion: Vitamin K antagonists allowed less heparin requirement despite reaching higher ACT values and more efficient anticoagulation control (with more excessive values) compared to patients under DOAC therapy and to controls. There was no difference in heparin requirements or ACT between DOAC patients and controls.
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http://dx.doi.org/10.1002/joa3.12357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411209PMC
August 2020

Creation of sinus rhythm and paced maps using a single acquisition step: the "one acquisition-two maps" technique-a feasibility study.

J Interv Card Electrophysiol 2020 Jun 19. Epub 2020 Jun 19.

Department of Cardiology, University Hospital Rangueil, 31059, Toulouse, Cedex 09, France.

Purpose: Scars and abnormal electrograms may significantly differ according to the activation wavefront. We propose a new fast technique for reliable comparison between sinus rhythm and ventricular pacing using a single map acquisition and the Rhythmia™ 3D mapping system.

Methods: A special programming of the external stimulator was assuring full stable regular paced-beat bigeminy during spontaneous rhythm. A first map was acquired for the spontaneous cardiac beat. Then the window of detection was moved to the following paced beat, and a second map was available after recalculation by the system, depicting activation and voltage of the paced cardiac beat at the same locations, with an exactly the same number of beats in both maps.

Results: Thirty patients with structural heart disease referred for ablation of ventricular tachycardia underwent this protocol, who were compared with 19 similar patients undergoing repeated maps. Duration of the mapping was significantly shorter compared to controls (34 ± 12 vs 57 ± 14 min, p < 0.0001) without differences in the number of electrograms (6978 ± 7067 vs 9554 ± 4424 for sinus rhythm map and 6610 ± 7240 vs 7783 ± 3804 for paced map, p = ns for both). The technique cannot be completed in five patients (17%), because of arrhythmogenicity, mechanical right bundle branch block, hemodynamical impairment, or bradycardia.

Conclusion: We propose a novel technique for performing maps during sinus rhythm and ventricular pacing using a single acquisition. Beside time saving, this will allow more strict comparisons between different activation wavefronts.
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http://dx.doi.org/10.1007/s10840-020-00793-zDOI Listing
June 2020

Termination of sustained ventricular fibrillation by catheter ablation.

Eur Heart J 2020 08;41(30):2847

Cardiology, University Hospital Rangueil, 1 av Jean Poulhès, 31059 Toulouse, France.

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http://dx.doi.org/10.1093/eurheartj/ehaa243DOI Listing
August 2020

Chest pain in Brugada syndrome: Prevalence, correlations, and prognosis role.

Pacing Clin Electrophysiol 2020 04 26;43(4):365-373. Epub 2020 Feb 26.

Department of Cardiology, University Hospital Rangueil, Toulouse, France.

Background: Brugada syndrome (BrS) is sometimes diagnosed because of chest pain. Prevalence and characteristics of such BrS patients are unknown.

Methods: A total of 200 BrS probands were retrospectively included. BrS diagnosis made because of chest pain (n = 34, 17%) was compared to the other ones.

Results: BrS probands with diagnosis because of chest pain had significantly more often smoker habits, increased body mass index, and familial history of coronary artery disease but less frequently previous resuscitated sudden death/syncope or atrial fibrillation. Presence of coronary spasm and familial coronary artery disease were independently associated with BrS diagnosed because of chest pain. They presented more often with spontaneous type 1 ST elevation (59% vs 26%, P = .0004) and higher ST elevation during the episode of chest pain compared to other patients or compared to baseline electrocardiogram after chest pain resumption. ST elevation during chest pain was lower compared to ajmaline test. A total of 20% of them had significant coronary artery disease and four (11%) had coronary spasm, and they experienced more often recurrent chest pain episodes (24% vs 5%, P = .0002). Presence of chest pain at BrS diagnosis was not correlated to future arrhythmic events in univariate analysis. Only previous sudden cardiac death (SD)/syncope and familial SD were still significantly associated with outcome in multivariate analysis.

Conclusion: Chest pain is a common cause for BrS diagnosis, although major part is not apparently explained by ischemic heart disease. Mechanisms leading to chest main remain unknown in the other ones. ST elevation is higher in this situation but does not seem to carry poor prognosis.
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http://dx.doi.org/10.1111/pace.13881DOI Listing
April 2020

Severe and uniform bi-atrial remodeling measured by dominant frequency analysis in persistent atrial fibrillation unresponsive to ablation.

J Interv Card Electrophysiol 2020 Nov 13;59(2):431-440. Epub 2019 Dec 13.

Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.

Background: High values of ECG and intracardiac dominant frequency (DF) are indicative of significant atrial remodeling in persistent atrial fibrillation (peAF). We hypothesized that patients with peAF unresponsive to ablation display higher ECG and intracardiac DFs than those remaining in sinus rhythm (SR) on the long term.

Methods: Forty consecutive patients underwent stepwise ablation for peAF (sustained duration 19 ± 11 months). Electrograms were recorded before ablation at 13 left atrium (LA) sites and at the right atrial appendage (RAA) and coronary sinus (CS) synchronously to the ECG. DF was defined as the highest peak within the power spectrum.

Results: peAF was terminated within the LA in 28 patients (left-terminated [LT]), whereas 12 patients remaining in AF after ablation (not left-terminated [NLT]) were cardioverted. Over a mean follow-up of 34 ± 14 months, all 12 NLT patients had a recurrence. Of the LT patients, 71% had a recurrence (20/28, LT_Rec), while 29% remained in SR throughout the follow-up (8/28, LT_SR). DF values and correlations between pairs of LA appendage (LAA), RAA, and CS DFs showed distinctive patterns among the subgroups. The NLT subgroup displayed the highest ECG and intracardiac DFs, with strong intragroup homogeneity between pairs of CS and LAA DFs, and to a lesser extent between pairs of CS and RAA DFs. Conversely, the LT_SR subgroup showed the lowest DFs, with significant intragroup heterogeneity between pairs of CS and both LAA and RAA DFs.

Conclusions: Patients with peAF unresponsive to ablation show high surface and intracardiac DFs indicative of severe and uniform bi-atrial remodeling.
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http://dx.doi.org/10.1007/s10840-019-00681-1DOI Listing
November 2020

Feasibility of fast ventricular tachycardia mapping using the Rhythmia ™ system in a patient with an Impella ™.

Indian Pacing Electrophysiol J 2020 Jan - Feb;20(1):33-34. Epub 2019 Nov 18.

Department of Cardiology, University Hospital Rangueil, Toulouse, France.

Use of 3D navigation systems may be sometimes impossible in patients with left ventricular assist devices because of major electromagnetical interferences with some 3D systems based on magnetic localization. Mapping with the Rhythmia ™ system in patients implanted with an Impella ™ is described to be non feasible. We relate how to overcome this technical issues in this case.
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http://dx.doi.org/10.1016/j.ipej.2019.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994303PMC
November 2019

Early Ventricular Arrhythmias After LVAD Implantation Is the Strongest Predictor of 30-Day Post-Operative Mortality.

JACC Clin Electrophysiol 2019 08 19;5(8):944-954. Epub 2019 Aug 19.

Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France.

Objectives: This study aimed to evaluate incidence, clinical significance, and predictors of early ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients.

Background: LVAD implantation is increasingly used in patients with end-stage heart failure. Early VAs may occur during the 30-day post-operative period, but many questions remain unanswered regarding their incidence and clinical impact.

Methods: This observational study was conducted in 19 centers between 2006 and 2016. Early VAs were defined as sustained ventricular tachycardia and/or ventricular fibrillation occurring <30 days post-LVAD implantation and requiring appropriate implantable cardioverter-defibrillator therapy, external electrical shock, or medical therapy.

Results: A total of 652 patients (median age: 59.8 years; left ventricular ejection fraction: 20.7 ± 7.4%; HeartMate 2: 72.8%; HeartWare: 19.5%; Jarvik 2000: 7.7%) were included in the analysis. Early VAs occurred in 162 patients (24.8%), most frequently during the first week after LVAD implantation. Multivariable analysis identified history of VAs prior to LVAD and any combined surgery with LVAD as 2 predictors of early VAs. The occurrence of early VAs with electrical storm was the strongest predictor of 30-day post-operative mortality, associated with a 7-fold increase of 30-day mortality. However, in patients discharged alive from hospital, occurrence of early VAs did not influence long-term survival.

Conclusions: Early VAs are common after LVAD implantation and increase 30-day post-operative mortality, without affecting long-term survival. Further studies will be needed to analyze whether pre- or pre-operative ablation of VAs may improve post-operative outcomes. (Determination of Risk Factors of Ventricular Arrhythmias After Implantation of Continuous Flow Left Ventricular Assist Device With Continuous Flow Left Ventricular Assist Device [ASSIST-ICD]; NCT02873169).
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http://dx.doi.org/10.1016/j.jacep.2019.05.025DOI Listing
August 2019

Atrial Tachycardia With Atrial Activation Duration Exceeding the Tachycardia Cycle Length: Mechanisms and Prevalence.

JACC Clin Electrophysiol 2019 08 31;5(8):907-916. Epub 2019 Jul 31.

Department of Cardiology, University Hospital Haut-Lévèque, Pessac, France; LIRYC Institute/INSERM 1045, Bordeaux University Hospital, Bordeaux, France.

Objectives: This study sought to identify atrial tachycardia (AT) demonstrating atrial activation duration (AAD) lasting longer than the length of the tachycardia cycle (TCL); to assess AT prevalence; and to evaluate the mechanisms and characteristics associated with these AT episodes by using the Rhythmia system (Boston Scientific, Marlborough, Massachusetts).

Background: Ultra-high-density mapping allows very accurate characterization of mechanisms involved in AT. Some complex patterns may involve AAD which is longer than the tachycardia cycle length (TCL) which makes maps difficult to interpret. Prevalence and characteristics of such ATs are unknown.

Methods: A cohort of 100 consecutive patients undergoing ablation of 125 right (n = 21) or left (n = 104) ATs using ultra-high-density mapping were retrospectively included. Offline calculation of right or left AAD was compared to TCL.

Results: Mean TCL was 293 ± 65 ms, and mean AAD was 291 ± 74 ms (p = NS). AT mechanisms were macro-re-entry in 74 cases (59%), localized re-entry in 27 cases (22%), and focal AT in 21 cases (17%) (types were mixed in 3 cases). Fifteen ATs (12%) had AADs that were longer than the TCL (71 ± 45 ms longer, from 10 to 150 ms). TCL was equal to the AAD in 97 ATs (78%), whereas 13 ATs (10%) had AAD shorter than the TCL (focal AT in each case). There were no differences between right and left atria for prevalence of ATs with AADs that were longer than the TCLs. There were significant differences in AT mechanisms according to the AAD-to-TCL ratio (p < 0.0001), with localized re-entry showing more often that AAD was longer than the TCL compared to that in focal AT and macro-re-entry.

Conclusions: ATs with AAD lasting longer than the TCL were present in approximately 10% of the ATs referred for ablation, mostly in ATs caused by localized re-entry. Ultra-high-density mapping allows detection of these complex patterns of activation.
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http://dx.doi.org/10.1016/j.jacep.2019.04.015DOI Listing
August 2019

Correlations between arrhythmogenic substrate and noninvasive risk stratification in ischemic heart disease patients modifications by radiofrequency ablation.

J Cardiovasc Electrophysiol 2019 11 29;30(11):2344-2352. Epub 2019 Aug 29.

Department of Cardiology, University Hospital Rangueil, Toulouse, France.

Introduction: Several noninvasive risk factors for ventricular arrhythmias have been described in postmyocardial infarction (MI) patients, whose relationships with scar characteristics and modifications by ablation are unknown.

Methods: Twenty-two patients with previous MI referred for ventricular tachycardia ablation were prospectively included. ECG, heart rate variability (HRV), signal-averaged ECG (SA-ECG), and T wave alternans (TWA) were performed before and after radiofrequency ablation. Scar areas were correlated to preablation parameters. Pre and postablation parameters were furthermore compared.

Results: Left ventricular ejection fraction and some spectral and time-domain HRV parameters were significantly correlated to the scar areas. QRS duration was larger after vs before ablation (120 ± 29 vs 105 ± 22 msec, P = .01). No significant modification in time or spectral domain of HRV was observed. There was no significant change in TWA and SA-ECG before and after ablation. Borderline decreases in quantitative TWA parameters were noted in patients with positive TWA and successful ablation procedure.

Conclusion: Some noninvasive risk factors were linked to the scar areas, but few were significantly modified after ablation. Larger populations are needed to demonstrate significant differences or correlations.
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http://dx.doi.org/10.1111/jce.14136DOI Listing
November 2019

Atrial fibrillation and subtype of atrial fibrillation in cardiac amyloidosis: clinical and echocardiographic features, impact on mortality.

Amyloid 2019 Sep 7;26(3):128-138. Epub 2019 Jun 7.

a Department of Cardiology, Rangueil University Hospital , Toulouse , France.

Atrial fibrillation (AF) commonly affects patients with cardiac amyloidosis (CA). Amyloid deposition within the left atrium may be responsible for the subtype of AF in either permanent or non-permanent form. The prognostic implications of AF and its clinical subtype according to the type of CA are still controversial in this population. This study sought to investigate the prevalence, incidence and prognostic implications of AF and the clinical subtype of AF (permanent or non-permanent) in patients with CA. Two hundred and thirty-eight patients with CA and full medical records were retrospectively enrolled in the study: About 115 (48%) with light chain (AL) amyloidosis and 123 (52%) with transthyretin amyloidosis (ATTR). Patient's medical records were reviewed to establish baseline prevalence, incidence and impact on all-cause and cardiovascular mortality during follow-up of AF. One hundred and four (44%) patients had history of AF at the time of diagnosis: 62 (60%) permanent and 42 (40%) non-permanent. There were 30 (26%) and 74 (60%) patients with history of AF among patients with AL and ATTR (including 5 hereditary and 69 wild-type), respectively (<.0001). During the follow-up, 48 new patients developed AF (29, 12 and 7 among patients with AL, wild-type ATTR and hereditary ATTR). After adjustment for age, survival was similar in patients with or without history of AF (HR 0.87 (95% CI, 0.60 to 1.27;  = .467). AF had no impact on cardiovascular mortality. Among the 152 patients with history of AF included in the whole study, there were 75 (49%) patients with permanent AF. After adjustment for age, survival was similar in patients with permanent and non-permanent AF: HR 1.29 (95% CI, 0.84 to 1.99;  = .251). The results were the same among patients with AL or wild-type amyloidosis. Subtype of AF had no impact on cardiovascular mortality. AF is common in patients with CA. However, AF and clinical subtype of AF have no impact on all-cause mortality, whatever the type of amyloidosis.
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http://dx.doi.org/10.1080/13506129.2019.1620724DOI Listing
September 2019

Development and Validation of a New Risk Prediction Score for Life-Threatening Ventricular Tachyarrhythmias in Laminopathies.

Circulation 2019 07 3;140(4):293-302. Epub 2019 Jun 3.

APHM, Centre de référence des maladies neuromusculaires PACA-Réunion-Rhône Alpes, Hôpital Timone; Aix Marseille Université, Inserm UMR_S 910, GMGF, France (E.S.).

Background: An accurate estimation of the risk of life-threatening (LT) ventricular tachyarrhythmia (VTA) in patients with LMNA mutations is crucial to select candidates for implantable cardioverter-defibrillator implantation.

Methods: We included 839 adult patients with LMNA mutations, including 660 from a French nationwide registry in the development sample, and 179 from other countries, referred to 5 tertiary centers for cardiomyopathies, in the validation sample. LTVTA was defined as (1) sudden cardiac death or (2) implantable cardioverter defibrillator-treated or hemodynamically unstable VTA. The prognostic model was derived using the Fine-Gray regression model. The net reclassification was compared with current clinical practice guidelines. The results are presented as means (SD) or medians [interquartile range].

Results: We included 444 patients, 40.6 (14.1) years of age, in the derivation sample and 145 patients, 38.2 (15.0) years, in the validation sample, of whom 86 (19.3%) and 34 (23.4%) experienced LTVTA over 3.6 [1.0-7.2] and 5.1 [2.0-9.3] years of follow-up, respectively. Predictors of LTVTA in the derivation sample were: male sex, nonmissense LMNA mutation, first degree and higher atrioventricular block, nonsustained ventricular tachycardia, and left ventricular ejection fraction (https://lmna-risk-vta.fr). In the derivation sample, C-index (95% CI) of the model was 0.776 (0.711-0.842), and the calibration slope 0.827. In the external validation sample, the C-index was 0.800 (0.642-0.959), and the calibration slope was 1.082 (95% CI, 0.643-1.522). A 5-year estimated risk threshold ≥7% predicted 96.2% of LTVTA and net reclassified 28.8% of patients with LTVTA in comparison with the guidelines-based approach.

Conclusions: In comparison with the current standard of care, this risk prediction model for LTVTA in laminopathies significantly facilitated the choice of candidates for implantable cardioverter defibrillators.

Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03058185.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.118.039410DOI Listing
July 2019

Hemodynamic consequences of premature ventricular contractions: Association of mechanical bradycardia and postextrasystolic potentiation with premature ventricular contraction-induced cardiomyopathy.

Heart Rhythm 2019 06 11;16(6):853-860. Epub 2018 Dec 11.

Department of Cardiology, University Hospital Rangueil, Toulouse, France; Unité Inserm U 1048, Toulouse, France. Electronic address:

Background: The relationships between hemodynamic consequences of premature ventricular contractions (PVCs) and development of premature ventricular contraction-induced cardiomyopathy (PVC-CM) have not been investigated.

Objective: The purpose of this study was to correlate concealed mechanical bradycardia and/or postextrasystolic potentiation (PEP) to PVC-CM.

Methods: Invasive arterial pressure measurements from 17 patients with PVC-CM and 16 controls with frequent PVCs were retrospectively analyzed. PVCs were considered efficient (ejecting PVCs) when generating a measurable systolic arterial pressure. PEP was defined by a systolic arterial pressure of the post-PVC beat ≥5 mm Hg higher than the preceding sinus beat. Every PVC was analyzed for 10 minutes before ablation, and the electromechanical index (EMi = number of ejecting PVCs/total PVC) and postextrasystolic potentiation index (PEPi = number of PVCs with PEP/total PVC) were calculated.

Results: EMi was 29% ± 31% in PVC-CM and 78% ± 20% in controls (P <.0001). PEPi was 41% ± 28% in PVC-CM and 14% ± 10% in controls (P = .001). There was no control in groups of low EMi or high PEPi. EMi and PEPi were not significantly correlated to left ventricular dimensions or function in PVC-CM patients. PVC coupling interval was related to both ejecting PVCs and PEP.

Conclusion: Patients with PVC-CM more often display nonejecting PVCs and PEP compared to controls.
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http://dx.doi.org/10.1016/j.hrthm.2018.12.008DOI Listing
June 2019

Comparison between novel and standard high-density 3D electro-anatomical mapping systems for ablation of atrial tachycardia.

Heart Vessels 2019 May 19;34(5):801-808. Epub 2018 Nov 19.

University Hospital Caen, Caen, France.

Ultra-high-density mapping allows very accurate characterization of circuits/mechanisms in atrial tachycardia (AT). Whether these advantages will translate into a better procedural or long-term clinical outcome is unknown. Sixty consecutive AT ablation procedures using ultra-high-density mapping (Rhythmia™, group 1) were retrospectively compared to 60 consecutive procedures using standard high-density mapping (Carto/NavX™, group 2) (total 209 AT, 79% left AT). A higher number of maps were performed in group 1 (4.8 ± 2.5 vs 3.2 ± 1.7, p = 0.0001) with similar acquisition duration (12 ± 5 vs 13 ± 6 min per map, p = ns), although with a greater number of activation points (10,543 ± 5854 vs 689 ± 1827 per map, p < 0.0001). AT location remained undetermined in 5 AT in group 1 vs 10 (p = 0.1). Mechanism remained undetermined in 5 AT from group 1 vs 11 (p = 0.06). Acute complete success was achieved in 77%, in both groups. At 1-year follow-up, AT recurred in 37% in group 1 vs 50% in group 2 (p = 0.046). There are less long-term recurrences after AT ablation using ultra-high-density mapping system compared to standard high-density 3D mapping, possibly because of a better comprehensive approach of AT mechanisms.
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http://dx.doi.org/10.1007/s00380-018-1307-1DOI Listing
May 2019

Mapping ventricular fibrillation ... another piece from the jigsaw.

Indian Pacing Electrophysiol J 2018 Nov - Dec;18(6):193-194. Epub 2018 Nov 5.

University Hospital Rangueil, Toulouse, France.

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http://dx.doi.org/10.1016/j.ipej.2018.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303162PMC
November 2018

Characteristics of Scar-Related Ventricular Tachycardia Circuits Using Ultra-High-Density Mapping: A Multi-Center Study.

Circ Arrhythm Electrophysiol 2018 10;11(10):e006569

LIRYC Institute/INSERM 1045, Bordeaux University Hospital (R.M., C.D., C.A.M., M.T., A.F., N.T., T.K., K.V., M.W., G.C., J.D., G.M., T.P., A.D., N.D., M. Hocini, M. Haïssaguerre, P.J., R.D., F.S.).

Background: Ventricular tachycardia (VT) with structural heart disease is dependent on reentry within scar regions. We set out to assess the VT circuit in greater detail than has hitherto been possible, using ultra-high-density mapping.

Methods: All ultra-high-density mapping guided VT ablation cases from 6 high-volume European centers were assessed. Maps were analyzed offline to generate activation maps of tachycardia circuits. Topography, conduction velocity, and voltage of the VT circuit were analyzed in complete maps.

Results: Thirty-six tachycardias in 31 patients were identified, 29 male and 27 ischemic. VT circuits and isthmuses were complex, 11 were single loop and 25 double loop; 3 had 2 entrances, 5 had 2 exits, and 15 had dead ends of activation. Isthmuses were defined by barriers, which included anatomic obstacles, lines of complete block, and slow conduction (in 27/36 isthmuses). Median conduction velocity was 0.08 m/s in entrance zones, 0.29 m/s in isthmus regions ( P<0.001), and 0.11 m/s in exit regions ( P=0.002). Median local voltage in the isthmus was 0.12 mV during tachycardia and 0.06 mV in paced/sinus rhythm. Two circuits were identifiable in 5 patients. The median timing of activation was 16% of diastole in entrances, 47% in the mid isthmus, and 77% in exits.

Conclusions: VT circuits identified were complex, some of them having multiple entrances, exits, and dead ends. The barriers to conduction in the isthmus seem to be partly functional in 75% of circuits. Conduction velocity in the VT isthmus slowed at isthmus entrances and exits when compared with the mid isthmus. Isthmus voltage is often higher in VT than in sinus or paced rhythms.
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http://dx.doi.org/10.1161/CIRCEP.118.006569DOI Listing
October 2018

High Density Mapping of Pre-Excitation 3D-Illustration of Anatomical Features.

J Atr Fibrillation 2018 Apr 30;10(6):1824. Epub 2018 Apr 30.

Boston Scientific, France.

While ablation of accessory pathways is usually performed without 3D mapping system, we present a case where high-density mapping helps in illustrating the anatomical features of epicardial and oblique AP connections.
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http://dx.doi.org/10.4022/jafib.1824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009784PMC
April 2018

Crossroads or "Flyovers" novel insights into ventricular tachycardia mechanisms: The path is twisting.

Pacing Clin Electrophysiol 2018 11 23;41(11):1564-1567. Epub 2018 Jul 23.

University Hospital La Pitié Salpétrière, Paris, France.

Diverging channels of activation may be observed in some ventricular tachycardia (VT) using ultra-high-density mapping. We present here cases of such diverging activation patterns as observed from 60 consecutive VT activation maps using the Rhythmia system™ (Boston Scientific, Marlborough, MA, USA). Diverging directions of activation in the same area with "crossroads" or "flyover" pattern can be traced, implying recording of independent multilayer channels. Adaptation of current automated recording by the 3D mapping system is mandatory for better investigating this phenomenon.
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http://dx.doi.org/10.1111/pace.13433DOI Listing
November 2018

Three-dimensional mapping in the electrophysiological laboratory.

Arch Cardiovasc Dis 2018 Jun - Jul;111(6-7):456-464. Epub 2018 Jun 7.

University Hospital Rangueil, 31059 Toulouse, France.

Investigation and catheter ablation of cardiac arrhythmias are currently still based on optimal knowledge of arrhythmia mechanisms in relation to the cardiac anatomy involved, in order to target their crucial components. Currently, most complex arrhythmias are investigated using three-dimensional electroanatomical navigation systems, because these are felt to optimally integrate both the anatomical and electrophysiological features of a given arrhythmia in a given patient. In this article, we review the technical background of available three-dimensional electroanatomical navigation systems, and their potential use in complex ablations.
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http://dx.doi.org/10.1016/j.acvd.2018.03.013DOI Listing
October 2018

Comprehensive Multicenter Study of the Common Isthmus in Post-Atrial Fibrillation Ablation Multiple-Loop Atrial Tachycardia.

Circ Arrhythm Electrophysiol 2018 06;11(6):e006019

Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, France (M.T., N.D., R.M., A.D., A.F., K.V., T.K., G.C., G.M., N.T., C.A.M., M.W., X.P., J.D., N.K., T.P., F.S., H.C., M. Hocini, M. Hai.ssaguerre, P.J.).

Background: Characteristics of multiple-loop atrial tachycardia (AT) circuits have never precisely examined.

Methods: In 193 consecutive post-atrial fibrillation ablation patients with AT, 44 multiple-loop ATs including 42 dual-loop AT and 2 triple-loop AT in 41 (21.2%) were diagnosed with the high-resolution mapping system and analyzed off-line.

Results: In dual-loop ATs, 3 types were identified: type M, a combination of 2 anatomic macroreentrant ATs (AMATs) in 19 (43.2%); type MN, with 1 AMAT and 1 non-AMAT in 12 (27.3%); and type N with 2 non-AMATs in 11 (25.0%). The remaining 2 triple-loop ATs (4.5%) were a combination of perimitral-, roof-dependent-, and non-AMAT. At least 1 AMAT was included in 33 (75.0%), and 1 non-AMAT in 25 (56.8%). Of the ATs with at least 1 non-AMAT circuit, a pulmonary vein formed part of the circuit in 16/25 (64.0%). The length of the common isthmus was 3.6±1.4 cm in type M, 1.6±0.7 cm in type MN, and 1.1±0.7 cm in type N (<0.0001). The area of the common isthmus was 12.92±7.68, 2.46±1.53, and 0.90±0.81 cm, in Type M, MN, and N (<0.0001). The narrowest width of the common isthmus was 1.8±0.7 cm, 1.1±0.3 cm, and 0.7±0.3 cm in type M, MN, and N (<0.0001), respectively. The electrograms in the common isthmus showed longer duration and lower voltage in type N, type MN, and type M (duration: 106±25 ms, 87±27 ms, and 69±27 ms; =0.006; and voltage: 0.06±0.02 mV, 0.22±0.21 mV, and 0.57±0.50 mV; <0.0001), respectively.

Conclusions: Multiple-loop ATs are complex, frequently including anatomic circuits. They have specific characteristics determined by the combination of AMAT and non-AMAT.
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http://dx.doi.org/10.1161/CIRCEP.117.006019DOI Listing
June 2018

Characteristics of Single-Loop Macroreentrant Biatrial Tachycardia Diagnosed by Ultrahigh-Resolution Mapping System.

Circ Arrhythm Electrophysiol 2018 02;11(2):e005558

From the Department of Cardiac Electrophysiology, Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universitaire de Bordeaux), Avenue de Magellan, 33604, Bordeaux-Pessac, France (T.K., R.M., A. Denis, M.T., A.F., N.T., G.M., G.C., M.W., K.V., C.A.M., N.A.J., J.D., N.K., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.); and Unité INSERM U1048, University Hospital Rangueil, Toulouse, France (A. Duparc, A.R., P.M.).

Background: Biatrial tachycardia (BiAT) is a rare form of atrial macroreentrant tachycardia, in which both atria form a critical part of the circuit. We aimed to identify the characteristics and precise circuits of single-loop macroreentrant BiATs.

Methods And Results: We identified 8 patients (median age, 59.5 years old) with 9 BiATs in a cohort of 336 consecutive patients from 2 institutions who had undergone AT catheter ablation using an automatic ultrahigh-resolution mapping system. Seven of the 8 patients had a history of persistent AF ablation, including septal or anterior left atrium ablation before developing BiAT. One of the 8 patients had a history of an atrial septal patch closure with a massively enlarged right atrium. Nine ATs (median cycle length, 334 ms; median 12 561 points in the left atrium; 8814 points in the right atrium) were diagnosed as single-loop macroreentrant BiATs. We observed 3 types of BiAT (1) BiAT with a perimitral and peritricuspid reentrant circuit (n=3), (2) BiAT using the right atrium septum and a perimitral circuit (n=3), and (3) BiAT using only the left atrium and right atrium septum (n=3). Catheter ablation successfully terminated 8 of the 9 BiATs.

Conclusions: All patients who developed BiAT had an electric obstacle on the anteroseptal left atrium, primarily from prior ablation lesions. In this situation, mapping of both atria should be considered during AT. Because 3 types of single-loop BiAT were observed, ablation strategies should be adjusted to the type of BiAT circuit.
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http://dx.doi.org/10.1161/CIRCEP.117.005558DOI Listing
February 2018

High density mapping of inappropriate sinus tachycardia further looks into potential mechanisms.

Indian Pacing Electrophysiol J 2017 Jul - Aug;17(4):116-119. Epub 2017 May 30.

Division of Cardiology, University Hospital Rangueil, Toulouse France.

Inappropriate sinus tachycardia (IST) is an incompletely understood condition associating unexpectedly fast sinus rates and debilitating symptoms whose management by sinus node modification/ablation demonstrated limited long-term success. We report about a case of IST who underwent two RF procedures using high density mapping system, highlighting some possibly specific features and discussing potential mechanisms.
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http://dx.doi.org/10.1016/j.ipej.2017.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527818PMC
May 2017

Still darkness on the edge of Brugada syndrome.

Pacing Clin Electrophysiol 2017 12 7;40(12):1331. Epub 2017 Nov 7.

University Hospital Rangueil, Toulouse, France.

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http://dx.doi.org/10.1111/pace.13211DOI Listing
December 2017

Shortening of the Short Refractory Periods in Short QT Syndrome.

J Am Heart Assoc 2017 May 31;6(6). Epub 2017 May 31.

University Hospital Rangueil, Toulouse, France

Background: Diagnosis of short QT syndrome (SQTS) remains difficult in case of borderline QT values as often found in normal populations. Whether some shortening of refractory periods (RP) may help in differentiating SQTS from normal subjects is unknown.

Methods And Results: Atrial and right ventricular RP at the apex and right ventricular outflow tract as determined during standard electrophysiological study were compared between 16 SQTS patients (QTc 324±24 ms) and 15 controls with similar clinical characteristics (QTc 417±32 ms). Atrial RP were significantly shorter in SQTS compared with controls at 600- and 500-ms basic cycle lengths. Baseline ventricular RP were significantly shorter in SQTS patients than in controls, both at the apex and right ventricular outflow tract and for any cycle length. Differences remained significant for RP of any subsequent extrastimulus at any cycle length and any pacing site. A cut-off value of baseline RP <200 ms at the right ventricular outflow tract either at 600- or 500-ms cycle length had a sensitivity of 86% and a specificity of 100% for the diagnosis of SQTS.

Conclusions: Patients with SQTS have shorter ventricular RP than controls, both at baseline during various cycle lengths and after premature extrastimuli. A cut-off value of 200 ms at the right ventricular outflow tract during 600- and 500-ms basic cycle length may help in detecting true SQTS from normal subjects with borderline QT values.
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http://dx.doi.org/10.1161/JAHA.117.005684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669178PMC
May 2017

Prevalence of early repolarisation pattern in children.

Int J Cardiol 2017 Sep 11;243:505-510. Epub 2017 May 11.

Children Hospital Toulouse, France.

Background: Prevalence of early repolarisation ECG pattern (ER) has been repetitively determined in adults, but has not been reported in large unselected children populations so far.

Methods: ECG from 1000 successive healthy children from birth to 17years old were prospectively recorded and analyzed. ER was defined by ≥0.1mV J point elevation in at least two contiguous inferior or lateral ECG leads. Correlations with age, gender, ethnic origin, physical activity, Sokolow index and heart rate were performed.

Results: Prevalence of ER pattern was 23,6% (95% CI 21-26.2%) and increased after 8years of age. ER was independently correlated to a non Caucasian origin and a higher Sokolow index, but not to gender or level of physical activity. ER was independently correlated to an older age in children with heart rate <100bpm, and to a slower heart rate in children ≥8yo.

Conclusion: ER is present in a quarter of children of various age and is related to ethnic origin, an older age, a slower heart rate and a higher Sokolow index.
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http://dx.doi.org/10.1016/j.ijcard.2017.05.046DOI Listing
September 2017

Ventricular arrhythmias and sudden death in tetralogy of Fallot.

Arch Cardiovasc Dis 2017 May 17;110(5):354-362. Epub 2017 Feb 17.

University Children Hospital, Toulouse, France; Marie-Lannelongue Hospital, Department of Congenital Heart Diseases, Le Plessis-Robinson, France.

Malignant ventricular arrhythmias and sudden cardiac death may late happen in repaired tetralogy of Fallot, although probably less frequently than previously thought, especially with the advent of new surgical techniques/management. Ventricular tachycardias are caused by reentry around the surgical scars/patches and valves. Many predictive factors have been proposed, which suffer from poor accuracy. There is currently no recommended indication for prophylactic implantable cardioverter defibrillator implantation-except maybe in the case of multiple risk factors-while radiofrequncy ablation may be proposed in secondary prevention with or even without a back-up implantable cardioverter defibrillator in selected cases. Repeated cardiological investigations and monitoring should be proposed for every operated patient.
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http://dx.doi.org/10.1016/j.acvd.2016.12.006DOI Listing
May 2017